doula care support intake

Please fill out this form thoroughly and I will arrange a call with your family soon so we may talk more in detail, and organize doula care for you + your new baby.

(For people who are not families seeking doula care, please contact me here.)

Name

First Name

Last Name

Checkbox

Please select the type(s) of doula care and services your family is interested in:

Birth Doula Care

Postpartum Night Doula Care

Twin Night Doula Care

Postpartum Meal Services

Postpartum Day Doula Care

Breastfeeding Care

Prenatal Doula Care

Homebirth or Birth Center Birth Consultation

Phone

Country

(###)

###

####

Due Date

YYYY

Location

What concerns do you have that you want to hire a doula to help you prevent or eliminate?

What are your biggest concerns you are forseeing as potential problems in birth or postpartum, and how would you like to combat these?

Do you currently have any fears for birth of postpartum?

Please explain

`Which Prenatal Care Plan do you want for your family

Are you aware of the c-section rate at your chosen hospital or with your OBGYN?

What is your current planned postpartum aftercare plan? This can include healing from the birth and preparing for nutrition needs

Are you planning a c-section or wanting to avoid one?

How are you looking to organize postpartum support for yourself? And what support will you have around you?

Are you wanting postpartum meals services with postpartum doula care?

Do you want baby to learn to sleep through the night or do you need postpartum doula support during the months you may be returning to work?

How do you see yourself being able to foster a relationship of mutual respect, teamwork, and the ability to implement strategies I as your doula will curate for your family?

How do you see the the role as a doula differs from other roles people mistakenly may view are comparable like a midwife, nanny/night nanny, newborn care specialist? And explain why you feel a doula is best for your needs and why you are committed to this type of care as a fit for you + your new baby.

What budget do you have in mind for doula care for your family?

Do you have any spiritual or religious practices you would like to include in your doula care plan or that you would like me to be aware of?